[Regulatory Content]
- If the annual number of outpatient visits exceeds 365, the beneficiary will be required to pay 30% of the total medical care costs for outpatient visits.
Exemptions apply to children, pregnant women, special treatment beneficiaries, and individuals with severe disabilities.
1. Reason for Amendment
The purpose of this amendment is to expand the medical care utilization options for beneficiaries by eliminating regulatory management systems such as the current benefit limit on days of care, extension approval, and the selective medical care provider system. Additionally, it aims to strengthen the responsibility of the state and local governments in managing appropriate benefit days and introduce a differential co-payment when the annual number of outpatient visits exceeds 365.
2. Key Contents
a. Eliminate the benefit limit on the number of care days, extension approval, and the selective medical care provider system, and stipulate that the state and local governments are responsible for managing appropriate benefit days (Article 8-3 of the Draft, etc.).
b. If the annual number of outpatient visits exceeds 365, the beneficiary must pay 30% of the total medical care cost for outpatient visits. Additionally, when outpatient visits exceed 180, 240, or 300 days, the beneficiary will be notified (Article 8-4 of the Draft and Annex 1-2).
c. Clearly define the timing of the inspection process for hearing aids, stating that an inspection must be conducted after purchasing the hearing aid and one month has passed (Annex 2, Item 1, Sub-item 5, and Annex Form 14-6).